| NPI | 1134613359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2306913) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2306913) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-07-31 |